It happened on a bus on my way to work. I got on and sat in the only available seat, which I quickly realized was next to a disheveled looking man who smelled faintly of urine and had a dry hacking cough that could be heard throughout the entire bus. He was leaning against the window and did not seem to notice me. I was less than pleased with my …
A medical student’s first day of clinical training started on the bus
This is another installment on how to ingratiate yourself with your new colleagues as a freshly minted MD intern (or medical student, for that matter). These are just observations on behavior that nurses tend to notice, which can really make a difference on how you’ll be received. I hope some of my suggestions are helpful in making you appear like the Star Intern that you know you are.
Introduce yourself. There is …
How to be a star intern, from a former nurse
Spent a sweaty week operating in a hilltop Hospital Nacional in Guatemala a while back.
A patient gave me a hat in thanks for her surgery. It’s a full-brimmed canvas safari number – I’m sure Hemingway shot a rhino in one. I’m just mature enough now to value sun protection and always grateful, sometimes to the point of pain, for gifts from those who have almost nothing. I was also …
If I could pick patients, they would be Native American Guatemalans
Simply put, habits are hard to break and bad habits like smoking, drinking, sedentary lifestyle and overeating are making our population sick. Who in the healthcare system can tackle these issues before they manifest into chronic disease?
Doctors are trained to diagnose and treat, but they aren’t trained to help people change their behavior, nor should they be since most physicians, particularly general practitioners, are already severely overloaded. Nurses provide …
Can health coaches help fix our healthcare system?
The revelations about the huge golden parachute given the outgoing CEO of ostensibly non-profit Massachusetts Blue Cross Blue Shield induced some public discussion about the disconnect between executive compensation and the mission of health care organizations.
First, new proxy statements revealed the compensation of executives of two large for-profit health care insurers/managed care companies.
Cigna
As reported by the AP, via ABC News, the CEO got a big raise:
Cigna Corp. CEO David …
Executive compensation and the rising cost of health care
Perhaps you’ve heard the news: psychiatrists no longer have time to listen to their patients. It’s all about writing prescriptions for medications and the days of “tell me about your mother” are long gone, or so we’re told. The current perception is that large volume practices where patients are seen in a matter of minutes are now standard and acceptable in psychiatry; that it’s how many — if not …
Are psychiatrists rushed, uncaring, and in it only for the money?
Sometimes you just don’t want to be right. Over the past 5 years, I have seen an alarming pattern arise in my profession. Many of my patients have heard me talk about Soylent Green, an old Charleton Heston movie. The premise of the movie seems absurd. Can you imagine the government of the United States providing for all the needs of its people including healthcare, food, clothing, and even death?
David …
Policy makers aren’t doctors, and why that’s a problem
Being a primary care doctor is an utter privilege. Think of this post as part proclamation and part journal entry.
Yesterday afternoon I sent out this tweet:
It was a spontaneous tweet in the middle of my 15 minute “lunch break” when I realized I still had hours to go in my clinical day. The motive was incredulity, not remorse or a …
Being a primary care doctor is an utter privilege
Health care is a team sport, and one of the most important members is the office receptionist.
Receptionists are often the first people patients see when the visit the clinic. And those first impressions count.
In a recent piece from the New York Times, Pauline Chen notes a study of the responsibilities of the medical receptionist, and finds they impact …
Why receptionists are integral to the health care team
You have insurance and, supposedly, it covers your medicines. However, you still get stuck with a portion of the bill that the insurance company calls a “copay.” In some cases these copays can run more than $150/ month per medication (e.g. Enbrel). If you are on more than one of these expensive, branded medications the copays can really add up. What are your options?
1. Generic alternative. Always ask your doc if there …
Options when your drug copays are too expensive
Jackson’s blood pressure was low, and this had the emergency room physician scrambling, barking orders. A nurse was busy at each arm, attempting to place large-bore IV’s so that fluids could be given rapidly and thus improve the low blood pressure. Other nurses were preparing strong antibiotics for immediate administration. An automated blood pressure cuff was attached to the left arm, inflating every 3-4 minutes with a characteristic grinding …
The inevitability of AIDS and the presence of addiction
Erik’s wife had warned him many times, “Stay off ladders dear, leave it to someone younger.” Erik though was a pretty spry 72 years old and had been cleaning the gutters for many years. He had a sturdy 25 foot extension ladder, had years of experience as an athlete, and wasn’t about to slow down for no good reason.
It was an unusually bright crisp November day in Seattle, when Erik …
The secret in caring for the patient is to care for the patient
As a middle-aged physician all too aware of the fact that we are all merely “passing through” life on our way to somewhere else, I am increasingly concerned with having a good work-life balance. Gone are the days of my residency when I was only able to catch a couple of hours of sleep here and there and be lucky to have the time to eat a fast food …
A Physician Family Office for high net worth families
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Medical malpractice reform is one of the few health care policy issues where there is a real possibility of agreement between the White House and Congress. A common refrain is that the fear of lawsuits leads physicians to practice defensive medicine, ordering too many tests just to cover their behinds in case of a lawsuit. It drives up costs without creating benefits. There’s some truth to this argument, …
Medical malpractice doesn’t address patient safety
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 52-year-old man is evaluated regarding treatment of his coronary artery disease. He had a myocardial infarction 8 years ago and was treated with a coronary stent placed in his right coronary artery. Over the last 8 years he did well with medical therapy, with only …
MKSAP: 52-year-old man with coronary artery disease
The scientific journal Nature ran an editorial recently with a rather ominous headline: “Psychopharmacology in Crisis.” What exactly is this “crisis” they speak of? Is it the fact that our current psychiatric drugs are only marginally effective for many patients? Is it the fact that they can often cause side effects that some patients complain are worse than the original disease? No, the “crisis” is that the …
Current psychiatric drugs are only marginally effective
When working with a patient population with chronic and terminal illnesses, very often, stressful and difficult conversations take place frequently. Often the news is not good or not what the person wants to hear. Having the assessment skills and knowledge about how to read body language and react accordingly to manage the interaction in a positive way are important skills to have.
Here are 5 tips that can help you navigate difficult …
Reading body language to help navigate difficult patient interactions
Washington has been touting Accountable Care Organizations (ACOs) as the end-all solution to health care’s woes. Designed to reduce Medicare spending and increase care coordination across a large number of patients, members of an ACO – hospitals, primary care physicians, specialists – would be paid if and when their patient population received outstanding quality of care. However, as the Centers for Medicare and Medicaid Services (CMS) finalize their ACO …
The value of Accountable Care Organizations (ACOs)
I recently saw a post in Yahoo questions entitled, “Is it illegal for a medical student to introduce themselves as ‘Doctor’ before they have received their MD?”
One of the answers that was rated highly was “I think it is more unethical than illegal.” Clearly, if a student is deliberately misrepresenting themselves as a ‘doctor’, it is grounds for disciplinary action. More often than not, this misrepresentation …
Should medical students be introduced as Doctor?
I was present recently at a meeting between representatives of a hospital and the relatives of a recently deceased patient. The death had been the subject of an inquiry and in preparation for the inquest, the family had been given copies of the medical notes. A significant part of the meeting was spent, explaining the meaning and significance of various entries in the notes. Embarrassingly, some handwritten entries in …
Poor, illegible entries in medical notes can cost lives
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